Testing and Diagnosis at IVF New Jersey
At IVF New Jersey, we offer infertility testing in Hamilton, Short Hills, Somerset, and Freehold. Infertility, which is defined as one year of unprotected intercourse without getting pregnant, affects up to 15 percent of reproductive age couples. If you want to assess your ability to become pregnant, here are some rules to consider:
- Women in their twenties and early thirties should try to conceive for one year before being evaluated for infertility.
- Women aged 35-39 should try to get pregnant for about six months to one year before being evaluated for problems.
- Anyone older than 39 who is having trouble conceiving should consider seeing an infertility specialist for an evaluation after six months of unprotected intercourse.
Infertility can be caused by a female factor, a male factor, or a combination of the two. In some cases, the cause of infertility is unknown. Here is a list of tests we offer to determine the cause of infertility in Somerset, Short Hills, Hamilton, and Freehold at IVF New Jersey.
Female Factor Infertility Tests
1. Day 2 or 3 follicle stimulating hormone (FSH) and estradiol (E2) levels
On the second or third day of your menstrual cycle, you will be asked to come into IVF New Jersey for a blood test. The first day of your period is considered the first day of full flow. For instance, if you get your menses at 11:30 on a Monday night, Monday would be considered your first day. The timing of this test is important.
FSH is a hormone that is normally secreted by the pituitary gland in your brain. It is responsible for the recruitment of ovarian follicles during a normal menstrual cycle. As a woman ages, her ovarian reserve or supply of follicles decreases and subsequently the FSH levels rise. This test is important because elevated levels of FSH are associated with fewer available eggs and poor performance with in vitro fertilization.
An elevated estradiol level is also predictive of difficulty in achieving pregnancy.
An ultrasound is an imaging test which uses high frequency sound waves to provide a picture of what your uterus and ovaries look like. This infertility evaluation test can be performed transvaginally or transabdominally.
The usual method at IVF New Jersey is to do a transvaginal ultrasound. A sheath is placed over the ultrasound probe, which is then gently inserted into the vagina. A full bladder is not required for this procedure. We can then obtain images of your uterus and ovaries.
A baseline ultrasound, or ultrasound on day 2 or 3 of your cycle, is normally performed, and the number of follicles, or potential egg sacs, is counted. This basal follicle count is another way that we can assess your ovarian reserve.
3. Clomiphene citrate challenge test
The clomiphene citrate challenge test is a bioassay used to assess ovarian reserve. On day 3 of your cycle, you will come into the office for baseline blood work. Clomiphene is given as 2 tablets on days 5-9 of your cycle. Another blood test is then obtained on day 10. When comparing the blood work from day 3 and day 10, an exaggerated elevation in the FSH level is associated with poorer ovarian reserve.
The evaluation of the female reproductive tract, which includes the uterine cavity and fallopian tubes, is an essential part of the infertility evaluation at IVF New Jersey in Somerset, Hamilton, Short Hills, and Freehold. This is most commonly done by performing a hysterosalpingogram (HSG). An HSG involves the injection of a special “dye” through the cervix and observing its course through the uterus and fallopian tubes. An x-ray machine known as a fluoroscope is able to “see” the dye, and the images are projected onto a TV-like monitor. Uterine problems including scar tissue, fibroids, polyps, and congenital anomalies, as well as tubal blockage, are easily diagnosed by this procedure.
Most fertility clinics do not possess the equipment necessary to perform HSGs in their office. Their patients are often referred to a hospital or radiology suite, and have their infertility procedures performed by people they have never met and who are unfamiliar with their medical history. This setting contributes to the anxiety already present in women undergoing the infertility procedures. The physicians of IVF New Jersey are very sensitive to these issues and consequently they perform all HSGs themselves, in the comfortable setting of our Somerset office. Because the procedure is performed by IVF New Jersey physicians specifically trained in gynecologic surgery, they have the capability of administering a local anesthetic to minimize the pain sometimes associated with this test. The results of the HSG are shared with the patient at the conclusion of the procedure by an IVF New Jersey physician. This eliminates the delays of obtaining records or films from a hospital or radiology suite, allowing for a more expedient assessment and management of a couple or individual with infertility issues in Somerset , Hamilton, Freehold, or Short Hills.
The HSG is usually performed within 5-10 days after the first day of your last menstrual period. If you are not allergic, we recommend that you take 400mg of ibuprofen (Advil® or Motrin®) one hour before the exam. You will be asked to lie down as you would for a Pap smear. A speculum will be placed and your vaginal area will be prepared with a sterile iodine solution to prevent infection. A small catheter is then placed into the cervical canal and the dye is injected. You may feel some cramping at this point. The procedure will be over in one to two minutes.
At IVF New Jersey, our physicians utilize the most advanced HSG technology available, the OEC 9800 C-arm. This unit provides digital images with remarkable clarity and with a significant reduction in radiation exposure. In a case where a fallopian tube/s is found to be blocked during the HSG, this OEC 9800 C-arm allows the IVF New Jersey physicians to perform a procedure known as tubal catheterization. Under the guidance of digital images provided by the OEC 9800, catheters are inserted into the obstructed fallopian tube to dislodge the debris, dried cells, or mucous that may be causing the obstruction and infertility. The procedure is successful in opening at least one fallopian tube in 90 percent of women, with 60 percent of women conceiving following the procedure. Tubal catheterization is performed during the same appointment as the HSG, negating the need for more invasive abdominal surgery that would require hospitalization and a prolonged hospital stay.
For certain IVF New Jersey patients, another imaging study called a sonohysterogram may be required. A sonohysterogram (SHG) is a special ultrasound examination utilizing contrast media, usually a saline solution, to enhance visualization of the uterine endometrial cavity. It is used to determine the architecture of the endometrial cavity and possible source of infertility. Again, the optimal time to perform this test is 5-10 days after the 1st day of your last menstrual period. This test is similar to an HSG except that ultrasound is used rather than X-rays.
You will be asked to lie down as you would for a Pap smear. A speculum will be placed and your vaginal area will be prepared with a sterile iodine solution to prevent infection. A small catheter is then placed into the cervical canal and the saline solution will be injected to help visualize the uterine cavity. You may feel some cramping at this point. The image will be recorded on our ultrasound screen and your IVF New Jersey physician should be able to give you an immediate interpretation of the study. This infertility test usually takes about 20 to 30 minutes.
Your thyroid function and prolactin levels will be checked when you have your blood work drawn at IVF New Jersey. These hormones are sometimes responsible for infertility.
A laparoscopy may occasionally be indicated. It is a surgical procedure which is performed at IVF New Jersey in an outpatient setting; it is useful for evaluating the health of your uterus, fallopian tubes, ovaries, and pelvic region. A small incision is made in your umbilical area and CO2 gas is instilled into the abdominal cavity. A camera is placed through the incision to view the pelvic area. If necessary, further surgical/ infertility procedures can be performed (i.e., removal of an ovarian cyst, repair of a damaged fallopian tube, cauterization of endometriosis) through additional incisions made in the lower abdominal area. When the surgery is completed, the incisions will be surgically repaired and you will be allowed to go home.
A hysteroscopy may be indicated if something suspicious is seen within the uterine cavity on HSG or SHG. This surgical procedure is performed in an ambulatory setting at IVF New Jersey and is useful for removing polyps, fibroids, septums, and scar tissue from the uterus, as well as for opening proximal obstructions of the fallopian tubes that may be causing infertility. You will lie down as when you have a Pap smear. A speculum will be placed in the vaginal area and your cervix will be gently dilated using cervical dilators. A camera will be placed through the cervix into the uterine cavity. If anything suspicious is seen, it will be surgically repaired. When the infertility procedure is completed in Somerset , Hamilton, Short Hills, or Freehold, you will be taken to the recovery room and allowed to leave IVF New Jersey after a period of observation.
Male Factor Infertility Tests
1. Semen analysis
A semen analysis is a test used to evaluate a man’s fertility potential. Your husband will be asked to collect a specimen via masturbation into a container provided by your physician. He can produce the specimen either at the offices of IVF New Jersey or at home. If he produces the specimen at home, it is important that he delivers it to any of our offices within 1 hour. We generally recommend that the specimen be produced no less than 2 days and no longer then 5 days after the last act of ejaculation.
When we receive the specimen, we will place a few drops of the sample on a slide and examine it under a microscope. The number of sperm, motility, and morphology will be recorded.
There are certain criteria that we at IVF New Jersey use to judge a normal semen analysis. A normal count should be greater than or equal to 20 million sperm/mL of fluid. Motility refers to the movement of the sperm, and greater than or equal to 50 percent should have forward progression, or greater than or equal to 25 percent with rapid progression within 60 minutes of ejaculation. Morphology, which refers to the way the sperm appear, should be greater than or equal to 30 percent with normal forms.
If a sample is abnormal, it is not unusual to ask the patient’s partner to provide another specimen for confirmation.
2. Antisperm antibody
This infertility test involves discovering the presence of antibodies (proteins) that can attach to the head, neck, or tail of sperm. If antibodies are found to be attached to more than 60 to 70 percent of the sperm, an immunologic problem is suspected. An abnormal antisperm antibody test can be overcome by giving the male patient corticosteroids (seldom used), or more commonly by intrauterine insemination. If unsuccessful, in vitro fertilization utilizing the ICSI (Intracytoplasmic Sperm Injection) procedure at IVF New Jersey is very effective.
To learn more about these infertility tests offered in Freehold, Hamilton, Somerset, or Short Hills, and which one might be right for you, contact IVF New Jersey today.